Provider Demographics
NPI:1477707040
Name:COLLAZO, MAYRA M (MD, CTR)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:M
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:MD, CTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6689
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6689
Mailing Address - Country:US
Mailing Address - Phone:787-362-4440
Mailing Address - Fax:787-653-1314
Practice Address - Street 1:52 CALLE 2
Practice Address - Street 2:PASEO ALTO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5918
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:787-653-1314
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17368208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDM-17324-5OtherASSMCA
PRDM-17324-5OtherASSMCA